Action Points

While consumption of sugar-sweetened beverages in the U.S. has been declining, 71.4% of Americans get 10% or more of their daily calories from added sugar and one in 10 get a quarter or more of their calories from added sugar.

Consumption of sugar-sweetened beverages is increasing in most of the rest of the world, and the addition of caloric sweeteners to foods and beverages is linked to an increased risk of cardiometabolic problems.

The U.S. is no longer the world's leading consumer of sugar-sweetened foods and drinks on a per-capita basis, a new analysis has found, thanks to developing nations' rapidly growing access to packaged foods.

Moreover, while consumption of sugar-sweetened beverages in the U.S. has been declining, it's on the increase in most of the rest of the world, according to the study of global trends in sweetened-beverage and food sales, as well as policy initiatives designed to reduce such consumption, published in the journal Lancet Diabetes & Endocrinology.

Chile has overtaken the U.S. as the country with the highest per capita sales of sugar-sweetened beverages on earth, followed by Mexico and the U.S., Argentina, Saudi Arabia, and Germany.

But that doesn't let the U.S. off the hook, according to one of the study's authors.

"Even though we are doing better in the U.S., we are still not doing well," said Barry M. Popkin, PhD, of the University of North Carolina School of Public Health, Chapel Hill, who wrote the analysis with Corinna Hawkes, PhD, of the Centre for Food Policy, City University London.

"68% of the packaged foods and beverages sold in this country include added sugar in some form and other countries have adopted our retail food model," Popkin told MedPage Today. He noted that the traditional diet in Latin America has been largely replaced by a more typical Western diet in just the last two decades due to the greater availability of packaged, processed foods and the proliferation of fast-food retailers.

"Africa and the Middle East came later to the retail food consumption revolution, but now there is a convenience store in just about every village," Popkin said. "Mexico, Chile, Columbia and Argentina are all seeing dramatic rises in diabetes, and we will see the same thing in the Middle East and Africa in about a decade."

Popkin noted that the now strong evidence linking regular consumption of processed foods and beverages with added sugars to weight gain led the WHO to revise its guidelines earlier this year to call for the reduction of added sugar to less than 10% of total energy intake. A recent study found that 71.4% of Americans get 10% or more of their daily calories from added sugar and one in 10 get a quarter or more of their calories from added sugar.

When Popkin and Hawkes analyzed nutritional datasets from around the world, they found that consumption of sugar-sweetened beverages is rising fastest in low and middle-income countries in Latin America, the Caribbean, Africa, the Middle East, and Asia.

Latin America, North America, Australasia and Western Europe had the highest consumption of sugar-sweetened beverages, but Latin America was the only one of the four that has not seen recent declines in sugar consumption.

India has the lowest consumption of sugar-sweetened beverages of the areas analyzed, followed by Indonesia, Vietnam, Hong Kong, Egypt, and Mainland China. But the researchers noted that many of these countries are rapidly increasing their sugar intake.

"The data in our analysis show that some countries, such as China, Thailand, Brazil and Chile are facing growth in sales of sugar-sweetened beverages, whereas others such as the UK, Mexico, and the USA are seeing declines," they wrote.

Popkin and Hawkes called for government action, such as increased implementation of taxes on sugar-sweetened beverages. They noted that, as of May of this year, five countries -- Chile, Mexico, Finland, Hungary, and France -- have imposed such taxes.

"Sugar-sweetened beverages and processed food are major sources of added sugars in most countries," they wrote. "WHO has recommended the amount of added sugars be reduced in foods, but the evidence for the effectiveness of this recommendation is less clear than for that for sugar-sweetened beverages; a clear policy priority should be to reduce intake of these beverages."

They added that there is an urgent need for action in low- and middle-income regions where sugar consumption is increasing fastest, and there is also a need for more government action to further reduce sugar consumption in higher-income regions like North America.

"The evaluation of not only sugar taxes, but also new marketing controls and front-of-pack labelling, is important and represents one of the next frontiers -- namely, can these policies effectively reduce consumption of sugar-sweetened beverages and intake of total added sugars?" they wrote.

Purdue University researcher and professor of nutrition science Richard Mattes, PhD, agreed that it remains to be seen if these policy initiatives will alter the global obesity epidemic and improve global health.

"The science tells us that excess energy intake is a big problem, and foods with a lot of added sugars tend to be high in calories," he told MedPage Today. "But we don't really have the evidence to say that sugar is the major villain in the obesity epidemic. It may be one of many."

Grant support for this research was provided by the Robert Wood Johnson Foundation and the National Institutes of Health.

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